Sex differences in long-term mortality after stroke in INSTRUCT (INternational STRoke oUtComes sTudy)

Hoang T. Phan, Christopher L. Blizzard, Mathew J. Reeves, Amanda Thrift, Dominique Cadilhac, Jonathan Sturm, Emma Heeley, Petr Otahal, Vemmos Konstantinos, Craig Anderson, Priya Parmar, Rita Krishnamurthi, Suzanne Barker-Collo, Valery Feigin, Yannick Bejot, Norberto L. Cabral, Antonio Carolei, Simona Sacco, Nicolas Chausson, Stephane Olindo & 9 others Peter Rothwell, Carolina Silva, Manuel Correia, Rui Magalhães, Peter Appelros, Janika Kõrv, Riina Vibo, Cesar Minelli, Seana Gall

Research output: Contribution to journalArticleResearchpeer-review

Abstract

Background - Women are reported to have greater mortality after stroke than men, but the reasons are uncertain. We examined sex differences in mortality at 1 and 5 years after stroke and identified factors contributing to these differences. Methods and Results - Individual participant data for incident strokes were obtained from 13 population-based incidence studies conducted in Europe, Australasia, South America, and the Caribbean between 1987 and 2013. Data on sociodemographics, stroke-related factors, prestroke health, and 1- and 5-year survival were obtained. Poisson modeling was used to estimate the mortality rate ratio (MRR) for women compared with men at 1 year (13 studies) and 5 years (8 studies) after stroke. Study-specific adjusted MRRs were pooled to create a summary estimate using random-effects meta-analysis. Overall, 16 957 participants with first-ever stroke followed up at 1 year and 13 216 followed up to 5 years were included. Crude pooled mortality was greater for women than men at 1 year (MRR 1.35; 95% confidence interval, 1.24-1.47) and 5 years (MRR 1.24; 95% confidence interval, 1.12-1.38). However, these pooled sex differences were reversed after adjustment for confounding factors (1 year MRR, 0.81; 95% confidence interval, 0.72-0.92 and 5-year MRR, 0.76; 95% confidence interval, 0.65-0.89). Confounding factors included age, prestroke functional limitations, stroke severity, and history of atrial fibrillation. Conclusions - Greater mortality in women is mostly because of age but also stroke severity, atrial fibrillation, and prestroke functional limitations. Lower survival after stroke among the elderly is inevitable, but there may be opportunities for intervention, including better access to evidence-based care for cardiovascular and general health.

Original languageEnglish
Article numbere003436
Number of pages47
JournalCirculation: Cardiovascular Quality and Outcomes
Volume10
Issue number2
DOIs
Publication statusPublished - 1 Feb 2017

Keywords

  • incidence
  • mortality
  • risk factors
  • stroke
  • women

Cite this

Phan, Hoang T. ; Blizzard, Christopher L. ; Reeves, Mathew J. ; Thrift, Amanda ; Cadilhac, Dominique ; Sturm, Jonathan ; Heeley, Emma ; Otahal, Petr ; Konstantinos, Vemmos ; Anderson, Craig ; Parmar, Priya ; Krishnamurthi, Rita ; Barker-Collo, Suzanne ; Feigin, Valery ; Bejot, Yannick ; Cabral, Norberto L. ; Carolei, Antonio ; Sacco, Simona ; Chausson, Nicolas ; Olindo, Stephane ; Rothwell, Peter ; Silva, Carolina ; Correia, Manuel ; Magalhães, Rui ; Appelros, Peter ; Kõrv, Janika ; Vibo, Riina ; Minelli, Cesar ; Gall, Seana. / Sex differences in long-term mortality after stroke in INSTRUCT (INternational STRoke oUtComes sTudy). In: Circulation: Cardiovascular Quality and Outcomes. 2017 ; Vol. 10, No. 2.
@article{8ebfad428b35485bb1fe89ec2ca65987,
title = "Sex differences in long-term mortality after stroke in INSTRUCT (INternational STRoke oUtComes sTudy)",
abstract = "Background - Women are reported to have greater mortality after stroke than men, but the reasons are uncertain. We examined sex differences in mortality at 1 and 5 years after stroke and identified factors contributing to these differences. Methods and Results - Individual participant data for incident strokes were obtained from 13 population-based incidence studies conducted in Europe, Australasia, South America, and the Caribbean between 1987 and 2013. Data on sociodemographics, stroke-related factors, prestroke health, and 1- and 5-year survival were obtained. Poisson modeling was used to estimate the mortality rate ratio (MRR) for women compared with men at 1 year (13 studies) and 5 years (8 studies) after stroke. Study-specific adjusted MRRs were pooled to create a summary estimate using random-effects meta-analysis. Overall, 16 957 participants with first-ever stroke followed up at 1 year and 13 216 followed up to 5 years were included. Crude pooled mortality was greater for women than men at 1 year (MRR 1.35; 95{\%} confidence interval, 1.24-1.47) and 5 years (MRR 1.24; 95{\%} confidence interval, 1.12-1.38). However, these pooled sex differences were reversed after adjustment for confounding factors (1 year MRR, 0.81; 95{\%} confidence interval, 0.72-0.92 and 5-year MRR, 0.76; 95{\%} confidence interval, 0.65-0.89). Confounding factors included age, prestroke functional limitations, stroke severity, and history of atrial fibrillation. Conclusions - Greater mortality in women is mostly because of age but also stroke severity, atrial fibrillation, and prestroke functional limitations. Lower survival after stroke among the elderly is inevitable, but there may be opportunities for intervention, including better access to evidence-based care for cardiovascular and general health.",
keywords = "incidence, mortality, risk factors, stroke, women",
author = "Phan, {Hoang T.} and Blizzard, {Christopher L.} and Reeves, {Mathew J.} and Amanda Thrift and Dominique Cadilhac and Jonathan Sturm and Emma Heeley and Petr Otahal and Vemmos Konstantinos and Craig Anderson and Priya Parmar and Rita Krishnamurthi and Suzanne Barker-Collo and Valery Feigin and Yannick Bejot and Cabral, {Norberto L.} and Antonio Carolei and Simona Sacco and Nicolas Chausson and Stephane Olindo and Peter Rothwell and Carolina Silva and Manuel Correia and Rui Magalh{\~a}es and Peter Appelros and Janika K{\~o}rv and Riina Vibo and Cesar Minelli and Seana Gall",
year = "2017",
month = "2",
day = "1",
doi = "10.1161/CIRCOUTCOMES.116.003436",
language = "English",
volume = "10",
journal = "Circulation: Cardiovascular Quality and Outcomes",
issn = "1941-7713",
publisher = "American Heart Association",
number = "2",

}

Phan, HT, Blizzard, CL, Reeves, MJ, Thrift, A, Cadilhac, D, Sturm, J, Heeley, E, Otahal, P, Konstantinos, V, Anderson, C, Parmar, P, Krishnamurthi, R, Barker-Collo, S, Feigin, V, Bejot, Y, Cabral, NL, Carolei, A, Sacco, S, Chausson, N, Olindo, S, Rothwell, P, Silva, C, Correia, M, Magalhães, R, Appelros, P, Kõrv, J, Vibo, R, Minelli, C & Gall, S 2017, 'Sex differences in long-term mortality after stroke in INSTRUCT (INternational STRoke oUtComes sTudy)' Circulation: Cardiovascular Quality and Outcomes, vol. 10, no. 2, e003436. https://doi.org/10.1161/CIRCOUTCOMES.116.003436

Sex differences in long-term mortality after stroke in INSTRUCT (INternational STRoke oUtComes sTudy). / Phan, Hoang T.; Blizzard, Christopher L.; Reeves, Mathew J.; Thrift, Amanda; Cadilhac, Dominique; Sturm, Jonathan; Heeley, Emma; Otahal, Petr; Konstantinos, Vemmos; Anderson, Craig; Parmar, Priya; Krishnamurthi, Rita; Barker-Collo, Suzanne; Feigin, Valery; Bejot, Yannick; Cabral, Norberto L.; Carolei, Antonio; Sacco, Simona; Chausson, Nicolas; Olindo, Stephane; Rothwell, Peter; Silva, Carolina; Correia, Manuel; Magalhães, Rui; Appelros, Peter; Kõrv, Janika; Vibo, Riina; Minelli, Cesar; Gall, Seana.

In: Circulation: Cardiovascular Quality and Outcomes, Vol. 10, No. 2, e003436, 01.02.2017.

Research output: Contribution to journalArticleResearchpeer-review

TY - JOUR

T1 - Sex differences in long-term mortality after stroke in INSTRUCT (INternational STRoke oUtComes sTudy)

AU - Phan, Hoang T.

AU - Blizzard, Christopher L.

AU - Reeves, Mathew J.

AU - Thrift, Amanda

AU - Cadilhac, Dominique

AU - Sturm, Jonathan

AU - Heeley, Emma

AU - Otahal, Petr

AU - Konstantinos, Vemmos

AU - Anderson, Craig

AU - Parmar, Priya

AU - Krishnamurthi, Rita

AU - Barker-Collo, Suzanne

AU - Feigin, Valery

AU - Bejot, Yannick

AU - Cabral, Norberto L.

AU - Carolei, Antonio

AU - Sacco, Simona

AU - Chausson, Nicolas

AU - Olindo, Stephane

AU - Rothwell, Peter

AU - Silva, Carolina

AU - Correia, Manuel

AU - Magalhães, Rui

AU - Appelros, Peter

AU - Kõrv, Janika

AU - Vibo, Riina

AU - Minelli, Cesar

AU - Gall, Seana

PY - 2017/2/1

Y1 - 2017/2/1

N2 - Background - Women are reported to have greater mortality after stroke than men, but the reasons are uncertain. We examined sex differences in mortality at 1 and 5 years after stroke and identified factors contributing to these differences. Methods and Results - Individual participant data for incident strokes were obtained from 13 population-based incidence studies conducted in Europe, Australasia, South America, and the Caribbean between 1987 and 2013. Data on sociodemographics, stroke-related factors, prestroke health, and 1- and 5-year survival were obtained. Poisson modeling was used to estimate the mortality rate ratio (MRR) for women compared with men at 1 year (13 studies) and 5 years (8 studies) after stroke. Study-specific adjusted MRRs were pooled to create a summary estimate using random-effects meta-analysis. Overall, 16 957 participants with first-ever stroke followed up at 1 year and 13 216 followed up to 5 years were included. Crude pooled mortality was greater for women than men at 1 year (MRR 1.35; 95% confidence interval, 1.24-1.47) and 5 years (MRR 1.24; 95% confidence interval, 1.12-1.38). However, these pooled sex differences were reversed after adjustment for confounding factors (1 year MRR, 0.81; 95% confidence interval, 0.72-0.92 and 5-year MRR, 0.76; 95% confidence interval, 0.65-0.89). Confounding factors included age, prestroke functional limitations, stroke severity, and history of atrial fibrillation. Conclusions - Greater mortality in women is mostly because of age but also stroke severity, atrial fibrillation, and prestroke functional limitations. Lower survival after stroke among the elderly is inevitable, but there may be opportunities for intervention, including better access to evidence-based care for cardiovascular and general health.

AB - Background - Women are reported to have greater mortality after stroke than men, but the reasons are uncertain. We examined sex differences in mortality at 1 and 5 years after stroke and identified factors contributing to these differences. Methods and Results - Individual participant data for incident strokes were obtained from 13 population-based incidence studies conducted in Europe, Australasia, South America, and the Caribbean between 1987 and 2013. Data on sociodemographics, stroke-related factors, prestroke health, and 1- and 5-year survival were obtained. Poisson modeling was used to estimate the mortality rate ratio (MRR) for women compared with men at 1 year (13 studies) and 5 years (8 studies) after stroke. Study-specific adjusted MRRs were pooled to create a summary estimate using random-effects meta-analysis. Overall, 16 957 participants with first-ever stroke followed up at 1 year and 13 216 followed up to 5 years were included. Crude pooled mortality was greater for women than men at 1 year (MRR 1.35; 95% confidence interval, 1.24-1.47) and 5 years (MRR 1.24; 95% confidence interval, 1.12-1.38). However, these pooled sex differences were reversed after adjustment for confounding factors (1 year MRR, 0.81; 95% confidence interval, 0.72-0.92 and 5-year MRR, 0.76; 95% confidence interval, 0.65-0.89). Confounding factors included age, prestroke functional limitations, stroke severity, and history of atrial fibrillation. Conclusions - Greater mortality in women is mostly because of age but also stroke severity, atrial fibrillation, and prestroke functional limitations. Lower survival after stroke among the elderly is inevitable, but there may be opportunities for intervention, including better access to evidence-based care for cardiovascular and general health.

KW - incidence

KW - mortality

KW - risk factors

KW - stroke

KW - women

UR - http://www.scopus.com/inward/record.url?scp=85014629782&partnerID=8YFLogxK

U2 - 10.1161/CIRCOUTCOMES.116.003436

DO - 10.1161/CIRCOUTCOMES.116.003436

M3 - Article

VL - 10

JO - Circulation: Cardiovascular Quality and Outcomes

JF - Circulation: Cardiovascular Quality and Outcomes

SN - 1941-7713

IS - 2

M1 - e003436

ER -